Herpes Zoster Post-COVID-19 Vaccine

Abstract

A 63 years old female attended to the department of maxillofacial surgery complaining of developed pain and itch over the right side of her face with blurred vision and facial swelling. The patient cured a Covid-19 just before one year ago without any serious sequel. The patient stated that she received Oxford/AstraZeneca vaccine and one week later she began to have a typical clinical presentation of Herpes zoster (Figure A and B) affecting face and oral cavity. The area surrounding the erupted vesicles was flared and tender. Vital signs revealed heart rate was 88 beats/min, temperature 36.5-37.5°C, respiration rate 16 breaths/min, blood pressure was 145/85 mm.Hg, and oxygen saturation 92-96%. The laboratory investigations revealed ESR 25 mm/h, HGB 13.8 g/dL, WBC count of 8.88 103/uL, and lymphocyte count of 40.1x103/uL. The patient received suitable medications (acyclovir tablet, gatifloxacin ophthalmic solution 0.3%, fusidic acid ophthalmic ointment and paracetamol tablet) for one week and vesicles become dry without complications (which includes post-herpetic neuralgia, herpes zoster opthalmicus, acute retinal necrosis, Bell’s palsy, aseptic meningitis, encephalitis, peripheral motor neuropathy and bacterial infection of the skin). Inflammation of dorsal root ganglia or extra-medullary cranial nerve ganglia is the characteristic feature of Herpes zoster with eruption of skin and/or oral mucous membrane vesicles (Shingles) in the area supplied by the affected nerve. Aging increases the incidence of Herpes zoster while virus reactivation is preceded by injury, immune deterioration and immunosuppression drugs. Infection with Covid-19 deteriorate the function of immune system by lowering the cytotoxic T-lymphocyte CD4 and CD8 which raise the risk of Herpes zoster. Many researchers recorded reactivation of Herpes zoster after receiving antiviral vaccines with hepatitis A, hepatitis B and influenza. 

Figure 1: Photograph of the patient showing facial herpes zoster.